Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Institute for Lifecourse Development, University of Greenwich, London, UK.
BMC Gastroenterol. 2021 Jul 6;21(1):276. doi: 10.1186/s12876-021-01848-9.
BACKGROUND: Telephone therapist delivered CBT (TCBT) and web-based CBT (WCBT) have been shown to be significantly more clinically effective than treatment as usual (TAU) at reducing IBS symptom severity and impact at 12 months in adults with refractory IBS. In this paper we assess the cost-effectiveness of the interventions. METHODS: Participants were recruited from 74 general practices and three gastroenterology centres in England. Interventions costs were calculated, and other service use and lost employment measured and costed for one-year post randomisation. Quality-adjusted life years (QALYs) were combined with costs to determine cost-effectiveness of TCBT and WCBT compared to TAU. RESULTS: TCBT cost £956 more than TAU (95% CI, £601-£1435) and generated 0.0429 more QALYs. WCBT cost £224 more than TAU (95% CI, - £11 to £448) and produced 0.029 more QALYs. Compared to TAU, TCBT had an incremental cost per QALY of £22,284 while the figure for WCBT was £7724. After multiple imputation these ratios increased to £27,436 and £17,388 respectively. Including lost employment and informal care, TCBT had costs that were on average £866 lower than TAU (95% CI, - £1133 to £2957), and WCBT had costs that were £1028 lower than TAU (95% CI, - £448 to £2580). CONCLUSIONS: TCBT and WCBT resulted in more QALYs and higher costs than TAU. Complete case analysis suggests both therapies are cost-effective from a healthcare perspective. Imputation for missing data reduces cost-effectiveness but WCTB remained cost-effective. If the reduced societal costs are included both interventions are likely to be more cost-effective. Trial registration ISRCTN44427879 (registered 18.11.13).
背景：电话治疗师提供的认知行为疗法（TCBT）和基于网络的认知行为疗法（WCBT）在减少难治性 IBS 成人的 IBS 症状严重程度和 12 个月时的影响方面，与常规治疗（TAU）相比，已被证明具有显著的临床效果。在本文中，我们评估了干预措施的成本效益。 方法：参与者从英格兰的 74 家普通诊所和 3 家胃肠病学中心招募。计算干预成本，并在随机分组后一年测量和计算其他服务使用和失业情况。将质量调整生命年（QALYs）与成本相结合，以确定 TCBT 和 WCBT 与 TAU 相比的成本效益。 结果：TCBT 比 TAU 多花费 956 英镑（95% CI，601-1435 英镑），并多产生 0.0429 个 QALY。WCBT 比 TAU 多花费 224 英镑（95% CI，-11 至 448 英镑），并多产生 0.029 个 QALY。与 TAU 相比，TCBT 的增量成本每 QALY 为 22284 英镑，而 WCBT 的增量成本为 7724 英镑。经过多次插补后，这些比率分别增加到 27236 英镑和 17388 英镑。包括失业和非正式护理在内，TCBT 的成本平均比 TAU 低 866 英镑（95% CI，-1133 至 2957 英镑），而 WCBT 的成本比 TAU 低 1028 英镑（95% CI，-448 至 2580 英镑）。 结论：TCBT 和 WCBT 比 TAU 产生了更多的 QALYs 和更高的成本。完全案例分析表明，从医疗保健的角度来看，两种疗法都具有成本效益。对缺失数据的插补降低了成本效益，但 WCBT 仍然具有成本效益。如果包括减少的社会成本，两种干预措施都可能更具成本效益。试验注册 ISRCTN44427879（注册于 2013 年 11 月 18 日）。
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